Health Care Reform

[halplm]

The solution is not that everyone pay for their costs sans insurance with prices as they are now, that is not workable, as I stated originally.

The prices have to be driven down, and weeded out of what is covered by insurance.


The government should not be in the business of telling people what is healthy or not for them to do. That should be each individual's responsibility to figure out with their doctor... or not if they don't want to bother.

This brings us to the cost of people showing up at the emergency room and then not being able to pay. Well, that's really a different problem than each person's individual health problems, isn't it?

[Cerin]

Is it true, as I have read, that Massachusetts has a state health care plan that is very similar to the Congressional bill under consideration, and that the new Senator-elect voted for that state plan?

I have heard or read it described that the Senate bill was similar to the Massachusetts plan, and that's one of the reasons Massachusans (?) didn't support it. It does not hold down costs.

I don't know if the Sen.-elect voted for that plan. Has he held office previously?

[Primula Baggins]

I don't think the government should be in the business of telling people what to do with their health.

However, if preventive care is freely available in community health clinics that people can get to, they will be more likely to use it. By choice. Other people won't, but when their conditions worsen, they'll have a place to go other than the ER.

I don't understand what force (assuming government orders aren't what you mean) is going to drive down the cost of basic medical care if no one can get insurance to cover it. I guess hypochondriacs would have to find another hobby, and people might find alternatives to going to the doctor every time they have a cold; but I know very few people like that. It seems to me that demand would stay about the same. And drug and medical equipment companies will have no motivation to suddenly charge less for their products. Why would they? What market force would create that?

[halplm]

Competition. If your doctor charges $100 an hour , while the guy accross the street only charges $50 an hour... well, he'll get the business.

Of course, if you like your doctor, you're free to keep going to him and paying the extra amount, it's your choice.

[Frelga]

To make each person responsible for their own health, we would have to start with each person carefully selecting their parents to avoid any genetic predispositions to heart disease, diabetes, etc. They also need to monitor the process of their conception to prevent any undesirable mutations.

We are not in control, exactly.

[Ellienor]

Hal, do you think the "Free Market" works in EVERY situation? Just curious. It seems that it is your answer to everything.

[halplm]

To make each person responsible for their own health, we would have to start with each person carefully selecting their parents to avoid any genetic predispositions to heart disease, diabetes, etc. They also need to monitor the process of their conception to prevent any undesirable mutations.

We are not in control, exactly.

Not of everythin, certainly, but we are in control of a lot. Even people that are predisposed to certain conditions can do a lot to prevent them from showing up.

Ellienor, I would not assume it worked in every situation, but it makes a lot of problems go away if allowed to operate correctly.

[Ellienor]

Well, Hal, if people don't take care of their health and don't have insurance, what do we do with them when they get sick? let them die on the street? That is the problem with applying the free market to health care. We won't let them die on the street, and somebody has to pay for it. And if that somebody is the government, and taxpayers, or insurance companies, and policyholders, what do we do?

[halplm]

Make them pay for it. We have a whole industry behind debt collection. if they go into debt, it's their own fault for not being prepared.

Sure, you're not going to get it all, every time, but that's a better choice than removing everyone elses freedom because some people are going to not take their own health seriously.

[Ellienor]

Make them pay for it. We have a whole industry behind debt collection. if they go into debt, it's their own fault for not being prepared.

Well, Hal, the people who go without tend to have nothing to lose. So, if they don't have it, there's nothing to be done. There's no debtor's prison in this country. They can also file for bankruptcy and get out of the debt.

So.....what do when somebody has cancer, and no insurance, and little in the way of assets? Do we treat them, or do they need to pony up first? And what do we do if there's nothing to collect, and/or they declare bankruptcy?

[Frelga]

Even if they go into debt, what then? If they have no income and no assets, what will you collect?

And if you can't collect, do you deny insulin to a diabetic and chemo treatment to a cancer patient?

Or - and this is where it's stops to be the problem of irresponsible individual - what if the condition is contagious? Tuberculosis, AIDS, hepatitis... Do we endanger other, responsible citizens by letting sick and poor among to go untreated? Or should I say, do we keep endangering them.

There is a reason it's called public health.

Edit: x-posted with Ellie

[Primula Baggins]

Somebody who makes $7.50 an hour is never going to be able to pay a $10,000 ER bill, Hal. Not in a hundred years. And what about someone who dies after that $10,000 worth of treatment?

What would happen is the hospitals would have to collect it from other people—people with insurance, people with money—by raising their prices for everyone else. Which is exactly what's happened.

The mess we're in right now is where free-market principles have put us. The fact is that the "free market" doesn't apply to health care, because people don't shop on price when their baby needs emergency heart surgery. And I can't imagine "Dr. Dan's Discount Duodenoscopies" hitting the Yellow Pages anytime soon. When it's their health, or a loved one's health, people want the best and latest treatment, end of story. There is no free market.

[River]

Is a system where the dollars in a person's pocket effectively determines whether or not they are worthy of living ethical? Moral? Acceptable? Why?

[Túrin Turambar]

I'd put it like this - there can be a free market, but many of usual advantages of one don't apply because of the unique inelasticity of the product.

A free market works on a price mechanism - consumers indicate to producers how much of a certain product they want through their willingness to buy, and producers make that product at that quantity accordingly. With healthcare, though, people seek to buy what they need rather than what they can afford. And this demand can be totally random - people don't look into getting open-heart surgery because they now have a six-figure income in the same way that they look into getting a boat. Similarly, someone who needs open-heart surgery will get it even if they need to declare bankruptcy to do so. A bank can’t re-possess medical treatment in the same way it can re-possess a house or car, so it needs to recoup its losses by charging those who can afford to pay.

[nerdanel]

Make them pay for it. We have a whole industry behind debt collection. if they go into debt, it's their own fault for not being prepared.

Sure, you're not going to get it all, every time, but that's a better choice than removing everyone elses freedom because some people are going to not take their own health seriously.

hal,

If you, personally, today, were diagnosed with something unforeseen like cancer (heaven forbid) that was not your fault: are you in a position to pay for all of your treatments? How would you feel about the application of the free market to your situation? First, are you able to pay out of pocket for necessary surgeries, chemo, etc.? (let's assume that you are right that prices are artificially high now - so are you able to pay, say, 50 percent of today's costs out of pocket?) If not, what option would you prefer? The one in which our society refuses you treatment, or the one in which our society gives you treatment and then commences debt collection proceedings to try to recover (likely) nonexistent money?

Also, assuming you are not able to pay for the cost of a full battery of cancer treatments (I certainly am not), does that mean that you are not taking your own health seriously or are not responsible? That seems to be what some of your posts explicitly state. If so, how do you propose to become more responsible/take your health more seriously, and is it something that the rest of us (who are similarly ill-equipped to pay for an unforeseen significant health condition out of pocket) can also learn from?

[halplm]

I have insurance, and I have gone through extraordinary means to keep that insurance constant for my entire adult life. So I am not the example your are asking about.

From what I can tell, all of you are suggesting that it is more important to force a system on anyone that makes things "equal" for those that are and aren't responsible on their own, than it is for people to be free to do as they wish.

What consequences are appropriate for irresponsible people that essentially steal from responsible ones?

I have not ever stated (although it seems to be that you all are attributing it to me) that we should deny health care to anyone that wants or needs it.

[River]

But what if you hadn't taken those measures? Or what if something awful happens to you and your insurer decides that it's better for their bottom line to just rescind your policy? It's currently legal for them to do that you know.

[halplm]

I don't even know what you guys think I've said at this point. I did not say the current insurance system was even good, much less without need of change.

What is the purpose of bringing up such a hypothetical situation? You're basically saying "how would you feel if you were an irresponsible idiot in need of medical treatment?"

[Primula Baggins]

The fact is that there is a benefit to society to providing decent health care for everyone—yes, a financial benefit. Just as there's a benefit from providing police and fire protection to everyone, even the people who are behind on their taxes. My neighbor's house being allowed to burn down would endanger my house and reduce its value. My neighbor's business going bankrupt so he can afford to pay for his cancer treatments would hurt my business, if it was next door to his, and hurt the community that depends on prosperous businesses to prosper itself. My neighbor dying because he can't afford treatment would cost more than just himself; maybe his house is foreclosed on, maybe his kids can't go to college, maybe his wife's health fails because she can't afford to pay for her own surgery or treatments, or the insurance that might save her.

We don't live in some libertarian vacuum where one person's mistake hurts only that person and no one else. It's better for society and the economy to keep people alive and healthy and working than to let them die on the street—just as it's better to educate children than abandon them to the street, no matter whose fault it is that they're poor; just as it's better to put out fires than let them burn, no matter who started the fire.

[halplm]

Ah yes, you're saying it's better for the community to punish good people to support the bad people... I understand.

Better for everyone to get minimal care, even if it costs responsible hardworking people the better care they've earned.

There's another word for that mentality, it's communism.

Doesn't matter if people have worked themselves to death their whole lives to make their business successful, and provide health and happiness for their family... it's better that they be forced to give some of that up for the "greater good." It's better to take AWAY their freedoms, than to hold anyone else responsible for their utter disregard for themselves and those around them.

I know, why don't we just force all doctors to work for the government! We can set their salaries (we'll wipe out their student loans of course, disregarding the ones that have slaved away for years to actually pay them off themselves), and they can treat everyone equally. Of course, because there aren't enough of them, some people will have to wait, and they might die in that time period. And of course, we'll want to treat young people more than old, because old people don't give anything to the community, they just take. Since we're giving everyone young frequent health checks to make sure they don't get sick in the prime of their life, we might not have time to get that 80 year old the hip replacement so they can enjoy life again. Oh, and there might not be any new doctors, because there are no incentives to become a doctor as it basically drafts you into slavery to the government and the "community." But why stop there? Why not nationalize small business. Surely the government can run those companies better than the pesky entrepreneurs that thought they had a good idea that could make a profit. After all profit is evil and can only be gained by taking that money from others, obviously less fortunate than the rich business owners (HA). Why not just have everyone work for the government? They can tell us everything we need to do from the moment we're born until we die at 30 (after all, the Carousel is a much better way to go than simple aging).

Who needs freedom when you can have complete absolution from any personal responsibility for your entire life?